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Gut Jul 1998The appropriate medical treatment of patients with ulcerative colitis is determined largely by the severity of symptoms. Hospital assessment of the severity of disease...
BACKGROUND
The appropriate medical treatment of patients with ulcerative colitis is determined largely by the severity of symptoms. Hospital assessment of the severity of disease activity includes investigation of laboratory indices and sigmoidoscopic assessment of mucosal inflammation.
AIMS
To develop a simplified clinical colitis activity index to aid in the initial evaluation of exacerbations of colitis.
METHODS
The information for development of the simple index was initially evaluated in 63 assessments of disease activity in patients with ulcerative colitis where disease activity was evaluated using the Powell-Tuck Index (which includes symptoms, physical signs, and sigmoidoscopic appearance). The new index was then further evaluated in 113 assessments in a different group of patients, by comparison with a complex index utilising clinical and laboratory data, as well as five haematological and biochemical markers of disease severity.
RESULTS
The newly devised Simple Clinical Colitis Activity Index, consisting of scores for five clinical criteria, showed a highly significant correlation with the Powell-Tuck Index (r = 0.959, p < 0.0001) as well as the complex index (r = 0.924, p < 0.0001) and all laboratory markers (p = 0.0003 to p < 0.0001).
CONCLUSIONS
This new Simple Colitis Activity Index shows good correlation with existing more complex scoring systems and therefore could be useful in the initial assessment of patients with ulcerative colitis.
Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Colitis; Colitis, Ulcerative; Female; Humans; Male; Middle Aged; Sensitivity and Specificity; Severity of Illness Index
PubMed: 9771402
DOI: 10.1136/gut.43.1.29 -
The Cochrane Database of Systematic... Jan 2018Endoscopic assessment of mucosal disease activity is routinely used to determine eligibility and response to therapy in clinical trials of ulcerative colitis. The... (Review)
Review
BACKGROUND
Endoscopic assessment of mucosal disease activity is routinely used to determine eligibility and response to therapy in clinical trials of ulcerative colitis. The operating properties of the existing endoscopic scoring indices are unclear.
OBJECTIVES
A systematic review was undertaken to evaluate the development and operating characteristics of endoscopic scoring indices for the evaluation of ulcerative colitis.
SEARCH METHODS
We searched MEDLINE, Embase and CENTRAL from inception to 5 July 2016. We also searched references and conference proceedings (Digestive Disease Week, United European Gastroenterology Week, European Crohn's and Colitis Organization).
SELECTION CRITERIA
Any study design (e.g. randomized controlled trials, cohort studies, case series) that evaluated endoscopic indices for evaluation of ulcerative colitis disease activity were considered for inclusion. Eligible participants were adult patients (> 16 years), diagnosed with ulcerative colitis using conventional clinical, radiologic and endoscopic criteria.
DATA COLLECTION AND ANALYSIS
Two authors independently reviewed the studies identified from the literature search. These authors also independently extracted and recorded data on the number of patients enrolled; number of patients per treatment arm; patient characteristics including age and gender distribution; endoscopic index; and outcomes such as reliability (intra-rater and inter-rater), validity (content, construct, criterion), responsiveness and feasibility. Any disagreements regarding study inclusion or data extraction were resolved by discussion and consensus with a third author. Risk of bias was assessed by determining whether assessors were blinded to clinical information and whether assessors scored the endoscopic index independently. We also assessed the methodological quality of the validation studies using the COSMIN checklist MAIN RESULTS: A total of 23 reports of 20 studies met the pre-defined inclusion criteria and were included in the review. Of the 20 included validation studies, 19 endoscopic scoring indices were assessed, including the Azzolini Classification, Baron Score, Blackstone Endoscopic Interpretation, Chinese Grading System of Ulcerative Colitis, Endoscopic Activty Index, Jeroen Score, Magnifying Colonoscopy Grade, Matts Score, Mayo Clinic Endoscopic Subscore, Modified Baron Score, Modified Mayo Clinic Endoscopic Subscore, Osada Score, Rachmilewtiz Endoscopic Score, St. Mark's Index, Ulcerative Colitis Colonoscopic Index of Serverity (UCCIS), endoscopic component of the Ulcerative Colitis Disease Activity Index (UCDAI), Ulcerative Colitis Endoscopic Index of Severity (UCEIS), Witts Sigmoidoscopic Score and Watson Grade. The individuals who performed the endoscopic scoring were blinded to clinical and/or histologic information in ten of the included studies, not blinded to clinical and/or histologic information in one of the included studies, and it was unclear whether blinding occurred in the remaining nine included studies. Independent observation was confirmed in four of the included studies, unclear in five of the included studies, and non-applicable (since inter-rater reliability was not assessed) in the remaining eleven included studies. The methodological quality (COSMIN checklist) of most of the included studies was rated as 'good' or 'excellent'. One study that assessed responsiveness was rated as 'fair'. The inter-rater reliability of nine endoscopic scoring indices including the Baron Score, Blackstone Endoscopic Interpretation, Endoscopic Activity Index, Matts Score, Mayo Clinic Endoscopic Subscore, Osada Score, UCCIS, UCEIS, Watson Grade was assessed in seven studies, with estimates of correlation, ƙ, ranging from 0.44 to 0.97. The iIntra-rater reliability of seven endoscopic scoring indices including the Baron Score, Blackstone Endoscopic Interpretation, Matts Score, Mayo Clinic Endoscopic Subscore, Osada Score, UCCIS and UCEIS was assessed in three studies, with estimates of correlation, ƙ, ranging from 0.41 to 0.86. No studies assessed content validity. Three studies evaluated the criterion validity of three endoscopic scoring indices including the Rachmilewitz Endoscopic Score, Magnifying Colonoscopy Grade and the UCCIS. These indices were correlated with objective markers of disease activity including albumin, blood leukocytes, C-reactive protein, fecal calprotectin, hemoglobin, mucosal interleukin-8 concentration and platelet count. Correlation estimates ranged from r = -0.19 to 0.83. Thirteen endoscopic scoring indices were tested for construct validity in 13 studies. Estimates of correlation between the endoscopic scoring indices and other measures of disease activity ranged from r = 0.27 to 0.93. Two studies explored the responsiveness of four endoscopic scoring indices including the Mayo Endoscopic Subscore, Modified Baron Score, Modified Mayo Endoscopic Subscore and UCEIS. One study concluded that the Modified Baron Score, Modified Mayo Endoscopic Subscore and UCEIS had similar responsiveness for detecting disease change in ulcerative colitis. The other included study concluded that the UCEIS may be the most accurate endoscopic scoring tool. None of the included studies formally assessed feasibility.
AUTHORS' CONCLUSIONS
While the UCEIS, UCCIS and Mayo Clinic Endoscopic Subscore have undergone extensive validation, none of these instruments have been fully validated and only two studies assessed responsiveness. Further research on the operating properties of these indices is needed given the lack of a fully-validated endoscopic scoring instrument for the evaluation of disease activity in ulcerative colitis.
Topics: Colitis, Ulcerative; Colonoscopy; Humans; Reproducibility of Results; Severity of Illness Index; Sigmoidoscopy
PubMed: 29338066
DOI: 10.1002/14651858.CD011450.pub2 -
American Family Physician Apr 2001Flexible sigmoidoscopy remains a common tool used for the periodic screening of colorectal cancer. Most organizations recommend screening at three- to five-year... (Review)
Review
Flexible sigmoidoscopy remains a common tool used for the periodic screening of colorectal cancer. Most organizations recommend screening at three- to five-year intervals beginning at age 50 for persons with average risk. Extensive training in endoscopic maneuvering, colorectal anatomy and pathologic recognition is required. Most physicians report comfort performing the procedure unsupervised after 10 to 25 precepted sessions. The procedure involves the insertion of the sigmoidoscope through the anus and distal rectum and advancement of the scope tip to an average depth of 48 to 55 cm in the sigmoid colon. Once the sigmoidoscope has been appropriately advanced, the scope is slowly withdrawn, allowing for the inspection of colon mucosa during withdrawal. Polyps less than 5 mm in diameter should be biopsied. Polyps 5 to 10 mm or greater can be assumed to be adenomatous, and follow-up colonoscopy for complete polypectomy is required. Diverticulosis, hemorrhoids, nonspecific colitis and pseudomembranes may also be encountered during inspection. Use of preprocedural benzodiazepines can be helpful in reducing patient discomfort. 2001;63:1375-80,1383-4,1385-8.)
Topics: Age Factors; Biopsy; Colonic Polyps; Colorectal Neoplasms; Family Practice; Humans; Intestinal Diseases; Intraoperative Complications; Preoperative Care; Sigmoidoscopy
PubMed: 11310651
DOI: No ID Found -
Canadian Medical Association Journal Mar 1974Sigmoidoscopy is the most important gastrointestinal procedure and is essential for the correct interpretation of lower bowel symptoms. The indications are many and...
Sigmoidoscopy is the most important gastrointestinal procedure and is essential for the correct interpretation of lower bowel symptoms. The indications are many and there are no contraindications. If done with care it is safe and inexpensive and within the capability of all practising physicians.Consideration for the patient's comfort and dignity, correct positioning, and advancement of the instrument only under direct vision should ensure a satisfactory examination.
Topics: Adult; Age Factors; Aged; Anus Diseases; Diet; Enema; Family Practice; Female; Fiber Optic Technology; Gastrointestinal Diseases; Humans; Male; Middle Aged; Palpation; Physician-Patient Relations; Posture; Rectal Diseases; Sigmoidoscopes; Sigmoidoscopy
PubMed: 4817215
DOI: No ID Found -
JNMA; Journal of the Nepal Medical... Dec 2022The rectal foreign body is a rare presentation, often related to sexual gratification, sexual assault, or the result of ingestion and rarely accidental, and with rising...
UNLABELLED
The rectal foreign body is a rare presentation, often related to sexual gratification, sexual assault, or the result of ingestion and rarely accidental, and with rising incidence. We present a case of a 47-year-old heterosexual male with an alleged history of accidental insertion of a foreign body through the anus three days prior without peritonitis or obstipation. After investigations, the patient underwent a failed sigmoidoscopic removal followed by exploratory laparotomy, foreign body removal, and an uneventful post-operative period. It should be noted that early diagnosis and timely intervention are important to prevent complications in rectal foreign bodies. Assessment of the shape, size, nature, and location of the object through appropriate imaging is necessary. Exploratory laparotomy is inevitable in cases of failed manual extraction techniques and complicated cases.
KEYWORDS
case reports; foreign bodies; laparotomy; rectum; sigmoidoscopy.
Topics: Humans; Male; Middle Aged; Rectum; Laparotomy; Foreign Bodies
PubMed: 36705106
DOI: 10.31729/jnma.7905 -
World Journal of Gastrointestinal... Jun 2016At a time where the incidence of colorectal cancer, a disease predominantly of developed nations, is showing a decline in those 50 years of age and older, data from the... (Review)
Review
At a time where the incidence of colorectal cancer, a disease predominantly of developed nations, is showing a decline in those 50 years of age and older, data from the West is showing a rising incidence of this cancer in young individuals. Central to this has been the 75% increase in rectal cancer incidence in the last four decades. Furthermore, predictive data based on mathematical modelling indicates a 124 percent rise in the incidence of rectal cancer by the year 2030 - a statistic that calls for collective global thought and action. While predominance of colorectal cancer (CRC) is likely to be in that part of the large bowel distal to the splenic flexure, which makes flexible sigmoidoscopic examination an ideal screening tool, the cost and benefit of mass screening in young people remain unknown. In countries where the incidence of young CRC is as high as 35% to 50%, the available data do not seem to indicate that the disease in young people is one of high red meat consuming nations only. Improvement in our understanding of genetic pathways in the aetiology of CRC, chiefly of the MSI, CIN and CIMP pathway, supports the notion that up to 30% of CRC is genetic, and may reflect a familial trait or environmentally induced changes. However, a number of other germline and somatic mutations, some of which remain unidentified, may play a role in the genesis of this cancer and stand in the way of a clear understanding of CRC in the young. Clinically, a proportion of young persons with CRC die early after curative surgery, presumably from aggressive tumour biology, compared with the majority in whom survival after operation will remain unchanged for five years or greater. The challenge in the future will be to determine, by genetic fingerprinting or otherwise, those at risk of developing CRC and the determinants of survival in those who develop CRC. Ultimately, prevention and early detection, just like for those over 50 years with CRC, will determine the outcome of CRC in young persons. At present, aside from those with an established familial tendency, there is no consensus on screening young persons who may be at risk. However, increasing awareness of this cancer in the young and the established benefit of prevention in older persons, must be a message that should be communicated with medical students, primary health care personnel and first contact doctors. The latter constitutes a formidable challenge.
PubMed: 27326317
DOI: 10.4251/wjgo.v8.i6.481 -
Journal of Clinical Pathology Oct 1979A patient is described in whom a campylobacter enteritis closely resembled ulcerative colitis on clinical, sigmoidoscopic, and histological grounds. Selective stool...
A patient is described in whom a campylobacter enteritis closely resembled ulcerative colitis on clinical, sigmoidoscopic, and histological grounds. Selective stool culture techniques may be necessary to differentiate campylobacter colitis from ulcerative colitis proper.
Topics: Adult; Campylobacter Infections; Colitis; Colitis, Ulcerative; Diagnosis, Differential; Female; Humans
PubMed: 521500
DOI: 10.1136/jcp.32.10.986 -
British Medical Journal Mar 1979Eleven consecutive patients with diarrhoea from whose stools campylobacter were isolated were investigated by sigmoidoscopy and rectal biopsy. Eight had definite...
Eleven consecutive patients with diarrhoea from whose stools campylobacter were isolated were investigated by sigmoidoscopy and rectal biopsy. Eight had definite proctitis, and in seven biopsy specimens were abnormal with histological changes ranging from non-specific colitis to gross colitis with goblet-cell depletion and crypt-abscess formation. Nine of the patients passed blood in their stools, and in all but one abdominal pain was a feature of the illness. Severe campylobacter colitis may be clinically, sigmoidoscopically, and histologically difficult to differentiate from ulcerative colitis and is a differential diagnosis in acute colitis.
Topics: Adolescent; Adult; Aged; Campylobacter Infections; Colitis; Diarrhea; Female; Humans; Male; Middle Aged; Rectum
PubMed: 435842
DOI: 10.1136/bmj.1.6167.857 -
Pakistan Journal of Medical Sciences 2022To determine the extent of ulcerative colitis and associated factors in patients who underwent sigmoidoscopy at Liver Center, Jail Road, Lahore, Pakistan.
OBJECTIVES
To determine the extent of ulcerative colitis and associated factors in patients who underwent sigmoidoscopy at Liver Center, Jail Road, Lahore, Pakistan.
METHODS
In this retrospective cohort study, patients who underwent sigmoidoscopy from July 2013 to July 2020 at Liver Clinic, Jail Road, Lahore, were categorized into two cohorts: who had ulcerative colitis confirmed on histology and who had no ulcerative colitis. Extent and severity of the disease as well as coexisting pathologies were also noted. SPSS version 25 was used. Independent sample T-test was applied to compare quantitative variables like age and weight, and chi-square test to compare qualitative variables with two cohorts. The p-value less than 0.05 was opted as significant. Odd ratio with 95% confidence interval (CI) were also computed for each association.
RESULTS
About 11.55% patients (165 out of 1428) had ulcerative colitis, whose mean age and mean weight were 38.27 ± 14.15 years and 74.08 ± 13.20 Kg respectively. Among ulcerative colitis patients, 18.2% had proctitis, 22.4% had proctosigmoiditis, 27.7% had left-sided colitis, and 31.5% had extensive colitis. May endoscopic severity score was found 0,1,2, and 3 in 12.1%, 23.6%, 31.5%, and 32.7% patients respectively. Ulcerative colitis cohort had significant association with younger age (p<0.01), female gender (p<0.01), non or former smoking (p=0.02) and presentation with bloody diarrhea (p<0.01), and no association with body weight (p=0.311), presence of diabetes mellitus (p=0.311) and family history of IBD (P=0.368).
CONCLUSION
Endoscopic extent and severity of ulcerative colitis is high in our studied population. Ulcerative colitis is more prevalent in younger age and female gender patients who presented with bloody diarrhea, while the presence of active smoking has negative association with finding the ulcerative colitis. However, presence of family history of IBD, diabetes mellitus and body weight of the patient has no statistical correlation with finding ulcerative colitis during sigmoidoscopic examination in our patients.
PubMed: 35035439
DOI: 10.12669/pjms.38.1.4648 -
World Journal of Gastroenterology Dec 2014To conduct a systematic review and meta-analysis of published population-based randomized controlled trials (RCTs). (Meta-Analysis)
Meta-Analysis Review
AIM
To conduct a systematic review and meta-analysis of published population-based randomized controlled trials (RCTs).
METHODS
RCTs evaluating the difference in mortality and incidence of colorectal cancer (CRC) between a screening flexible sigmoidoscopy (FS) group and control group (not assigned to screening FS) with a minimum 5 years median follow-up were identified by a search of MEDLINE and EMBASE databases and the Cochrane Central Register for Controlled Trials through August 2013. Random effects model was used for meta-analysis.
RESULTS
Four RCTs with a total of 165659 patients in the FS group and 249707 patients in the control group were included in meta-analysis. Intention-to-treat analysis showed that there was a 22% risk reduction in total incidence of CRC (RR = 0.78, 95%CI: 0.74-0.83), 31% in distal CRC incidence (RR = 0.69, 95%CI: 0.63-0.75), and 9% in proximal CRC incidence (RR = 0.91, 95%CI: 0.83-0.99). Those who underwent screening FS were 18% less likely to be diagnosed with advanced CRC (OR = 0.82, 95%CI: 0.71-0.94). There was a 28% risk reduction in overall CRC mortality (RR = 0.72, 95%CI: 0.65-0.80) and 43% in distal CRC mortality (RR = 0.57, 95%CI: 0.45-0.72).
CONCLUSION
This meta-analysis suggests that screening FS can reduce the incidence of proximal and distal CRC and mortality from distal CRC along with reduction in diagnosis of advanced CRC.
Topics: Colorectal Neoplasms; Early Detection of Cancer; Equipment Design; Humans; Incidence; Odds Ratio; Predictive Value of Tests; Randomized Controlled Trials as Topic; Risk Factors; Sigmoidoscopes; Sigmoidoscopy
PubMed: 25561818
DOI: 10.3748/wjg.v20.i48.18466